- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $1,412.54 / $3,235.94
| Facility | | $269.15 | $1,412.54 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $239.88 / $707.95
| Professional | | $95.50 | $239.88 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,174.90 / $3,801.89
| Facility | | $56.23 | $1,174.90 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | 53 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $275.42 / $741.31
| Professional | | $107.15 | $275.42 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $269.15
| Facility | | $114.82 | $114.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $64.57
| Facility | 53 | $28.84 | $28.84 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $407.38 / $676.08
| Professional | | $158.49 | $407.38 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $245.47 / $616.60
| Professional | | $112.20 | $245.47 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $131.83 / $3,311.31
| Facility | | $91.20 | $131.83 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $380.19 / $489.78
| Professional | | $316.23 | $380.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $2,511.89 / $7,079.46
| Facility | | $1,288.25 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $281.84 / $707.95
| Professional | | $107.15 | $281.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $1,148.15 / $4,365.16
| Facility | | $758.58 | $1,148.15 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $208.93 / $331.13
| Professional | | $114.82 | $208.93 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $1,174.90 / $3,801.89
| Facility | | $56.23 | $1,174.90 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- 53
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | 53 | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $275.42 / $741.31
| Professional | | $107.15 | $275.42 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $851.14 / $1,445.44
| Facility | | $389.05 | $851.14 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $954.99 / $2,089.30 / $5,623.41
| Facility | | $954.99 | $2,089.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $275.42 / $724.44
| Professional | | $109.65 | $275.42 | $724.44 |